Home testing questions

[Superman]

I agree with most of your summary points except one:

• Less time spent testing (5.3 minutes per test compared with 158
  minutes)

We spend less time testing but it is more like 30 to 45 minutes. My wife helps me clean up the table, scrub it down with soap and water, scrub our hands and use a thermophore heating pad for 3 to 5 minutes prior to the prick. We also set up the spreadsheet from the previous week to show which side of which finger to prick. Then, it is a couple minutes to enter the data into two different spreadsheets (to avoid loss in the far future). The data includes what the coumadin dosage was and whether there were unusual circumstances such as medicines or painkillers such as Tylenol. After this, we methodically put away all the equipment and close the software. The extra time is still far less then the time to drive to the Coumadin Clinic which I was doing every couple months prior to the epidemic. My time in range is not as good as yours and Pellicle's but is getting better.

Thank you again for your sample report sheet. It keeps my doctor and my Coumadin Clinic Pharmacist very content. I only send it to the M.D. once every couple months to reassure him that I am fine. I send it to the Coumadin Clinic about once a month. I told my M.D. that it is as much for me as for him as it keeps me from having strokes and bleeds (I had two large hematomas from taking a medicine that was NOT supposed to interact but DID that convinced me that I needed a home meter) When I tried to get a meter thru my health insurance, the rigamarole (sp?) was so great that he wrote me a prescription to get one by paying entirely on my own. I got a Coag-Sense on a bundle sale and it has worked perfectly for me. The CoagUChek folks wanted me to use their service and I did not wish to as my health plan has a Coumadin Clinic.

Walk in His Peace,
Scribe With A Lancet

Holy smokes!

- Set tester on the bathroom counter.
- Insert test strip.
- Wash and dry hands.
- Poke left side of right middle finger (always works).
- Apply sample to strip.
- Rinse off finger.
- Note result.
- Put it all away.
- Send an e-mail with result later.

Done in two or three minutes beginning to end.

I don’t keep a spread sheet because it’s one more thing to do. Historical results only ever satisfy curiousity without a detailed log of everything driving those results (diet, exercise, weight, sleep log, missed doses, etc). If I’m curious, I can look at archived emails or scroll back through tests on the machine. I only care about two things.

Am I in range?
If not, how should I change my dose to get back in range (if at all)?

My INR five years ago and the dose that got me there doesn’t matter one bit today. When I was in my 20’s, 4 - 4.5 mg’s kept me in range. Today, it’s around 6.

But, if you love spread sheets and have the free time - its all good.

I should add that everyone is different and variants in the condition of ones skin, quality of blood vessels, etc can all have an impact on ones experience. Some folks don’t recover from a finger poke as quick, so multiple testing spots matter more. My post reads a bit more rude than intended on a second read through. Apologies for that.

 

[Sheenas7]

Well I tested on my Vantus yesterday. I have a mechanical heart valve so my range is 2.5 to3.5.
It read 2.7 and I did it twice with the same result. I am in range so no changes. However since everyone has been noticing and me as well that the Vantus coagucheck XS can register higher than the blood draw, I skipped my salad yesterday. When I did a blood draw the last time, the lab was lower by .4. So that concerned me.

 

[dick0236]

I doubt that you will get a self-test and lab-test to routinely agree.........so which one do you trust more. I know you are new to INR and there is a learning curve so do what keeps you comfortable. I have had friends who never could get comfortable self-testing and went back to the lab......that's OK.

PS: My range is also 2.5-3.5 and I stay in that range about 80-85% of the time........and that's really good. My personal acceptable INR is 2.0-4-0 and for the past couple of years, I have been in that range 98% of the time.........and I have not had a lab draw for several years.

 

[pellicle]

But, if you love spread sheets and have the free time - its all good.

adds about another minute to my saturday ... perhaps another 10 minutes at end of year to create a new sheet.

I personally don't think all the other factors mentioned ( (diet, exercise, weight, sleep log, missed doses, etc) are of significance in the long term, and the data helps me and has helped me quickly assess and help others who have had problems getting into range and knowing what to do when INR shifts.

 

[pellicle]

I doubt that you will get a self-test and lab-test to routinely agree.........so which one do you trust more.

on the first point I find its seldom by more than 0.3INR units (so not clinically significant) on the second one I trust my meter.

 

[pellicle]

read 2.7 and I did it twice with the same result. I am in range so no changes

spot on ... love the good news stories

When I did a blood draw the last time, the lab was lower by .4. So that concerned me.

its not much difference, and how much time was between the lab draw and your own INR test? If Hours ok, if days its an invalid comparison. Dicks point is on the money on draws, but it is also the case that when I started INR testing it took a few goes before my technique was not to fault. Make sure you always test in a repeatable way and obey all the point in the manual

From my blog post: Managing my INR (some practical tips observations and theories) (if you've not read through it yet)

Getting Blood

...

So when doing this you need to follow the instructions of the device. I happen to use a Roche Coaguchek XS and it specifies 8µL or "a full haning drop". Actually getting enough blood is often not as easy as it sounds. Sure you can just give yourself a good scratch and get it, but if you do this frequently (I'll get onto that in a minute) its annoying to have what amounts to a permanent small injury on one of your fingers.

So, firstly on some mornings (I happen to test on Saturday mornings as my routine) I sometimes had trouble getting a good blood sample and would get the annoying "Error 5" displayed. This means you didn't get enough blood into the test strip and you'll have to toss the strip and try again. At $5 a hit its a slightly annoying thing to have happen ... it gets more annoying when you've blown two strips to finally get a reading with the third (meaning you've just cost $15 to check your INR).

My method is to lightly wrap a small rubber band (which I've cut to make it a small rubber strap) around my finger to act as a pressure bandage and to restrict the blood flow back up the vascular system. This means I can regularly get a reliable sized blood sample and (perhaps importantly) stay within the strict guidelines of Roche on the maximum permissible time that can pass between lancing and application (supposed to be 15 seconds, which I think is actually baseless, but that's a different post). From the Roche Coagucheck manual...

 

[slipkid]

spot on ... love the good news stories


its not much difference, and how much time was between the lab draw and your own INR test? If Hours ok, if days its an invalid comparison. Dicks point is on the money on draws, but it is also the case that when I started INR testing it took a few goes before my technique was not to fault. Make sure you always test in a repeatable way and obey all the point in the manual

From my blog post: Managing my INR (some practical tips observations and theories) (if you've not read through it yet)

Getting Blood

...

So when doing this you need to follow the instructions of the device. I happen to use a Roche Coaguchek XS and it specifies 8µL or "a full haning drop". Actually getting enough blood is often not as easy as it sounds. Sure you can just give yourself a good scratch and get it, but if you do this frequently (I'll get onto that in a minute) its annoying to have what amounts to a permanent small injury on one of your fingers.

So, firstly on some mornings (I happen to test on Saturday mornings as my routine) I sometimes had trouble getting a good blood sample and would get the annoying "Error 5" displayed. This means you didn't get enough blood into the test strip and you'll have to toss the strip and try again. At $5 a hit its a slightly annoying thing to have happen ... it gets more annoying when you've blown two strips to finally get a reading with the third (meaning you've just cost $15 to check your INR).

My method is to lightly wrap a small rubber band (which I've cut to make it a small rubber strap) around my finger to act as a pressure bandage and to restrict the blood flow back up the vascular system. This means I can regularly get a reliable sized blood sample and (perhaps importantly) stay within the strict guidelines of Roche on the maximum permissible time that can pass between lancing and application (supposed to be 15 seconds, which I think is actually baseless, but that's a different post). From the Roche Coagucheck manual...

Thx for the rubber band tip, I might try that.

I rarely get a big enough blood drop the first time (or any time). I have a new rule though & that is after I have sacrificed 2 fingers I give up and wait until next week. I used to go as far as 4-5 pricks but my fingers/hands just get too beat up doing that. I definitely have built up some callus type things. Good thing I don't play guitar anymore or I would probably not even be able to use a home meter (talk about big calluses, I would have nowhere to prick on my left hand other than my thumb). I am using a different lancer thing now though that I think is bigger than the old one, plus it has adjustments for depth which I could try if too problematic.

 

[slipkid]

Well I tested on my Vantus yesterday. I have a mechanical heart valve so my range is 2.5 to3.5.
It read 2.7 and I did it twice with the same result. I am in range so no changes. However since everyone has been noticing and me as well that the Vantus coagucheck XS can register higher than the blood draw, I skipped my salad yesterday. When I did a blood draw the last time, the lab was lower by .4. So that concerned me.

Depending on the valve the range might be different than 2.5 to 3.5. Unfortunately that is the long adapted standard and many Dr's in my experience have no idea that some valves have FDA approval for lower target ranges than that. My valve for instance (On-X) has a target range of 1.5 to 2.0. I like to test above 2 though just in case of fluctuations, but occasionally I dip below.

 

[slipkid]

Holy smokes!

- Set tester on the bathroom counter.
- Insert test strip.
- Wash and dry hands.
- Poke left side of right middle finger (always works).
- Apply sample to strip.
- Rinse off finger.
- Note result.
- Put it all away.
- Send an e-mail with result later.

Done in two or three minutes beginning to end.

Pretty much same for me. I was shocked to read above that someone was spending like 30-45 minutes for a self test.

I put a paper towel down on the kitchen table
Put the meter on that
Get a lancet set aside
Wash my hands in warm water for about 1 minute
Do the test, write the result in the logbook with the meter, and also on my calendar
Phone in the result

That is about it, expect that quite often I have to prick more than one finger to get a big enough blooddrop. I have started writing down in the logbook now what fingers I prick each week so I can try to avoid those the following week and use one better healed/softer/etc

 

[Warrick]

On the lab/ meter front I haven’t had a blood draw INR test since the 5 days I spent in hospital for my AVR in 2015.
My lab uses the XS plus (the flash hospital ones that get calibrated every day) and the most their test and mine have been out by is around 0.2 I think, so theres absolutely no reason not to fully trust my meter, although I’ll admit it did take me a while to have full faith in what I was doing.

 

[Sheenas7]

Depending on the valve the range might be different than 2.5 to 3.5. Unfortunately that is the long adapted standard and many Dr's in my experience have no idea that some valves have FDA approval for lower target ranges than that. My valve for instance (On-X) has a target range of 1.5 to 2.0. I like to test above 2 though just in case of fluctuations, but occasionally I dip below.

Interesting. I have the St Judes mitral since 2001.
Also permanent atrial fibrillations which I don’t feel because I have a complete heart block and thus I also have a pacemaker since 1974. Long road since my first surgery in 1957. That was pioneer surgery and caused me the complete heart block.

 

[Sheenas7]

I have two questions that I wonder if someone here knows the answer. First I use the Vantus and the service from Roche which was now bought by BioTel Heart, effective June 23, 2020. So far nothing has changed. I was told by letter.
Does the Vantus machine calibrate automatically? In other words the labs do a test to see if it is standardized. I may not be explaining this well. Does our machine self- checks itself that it is giving correct measurements and the strips are ok?
I remember there were re-calls and alerts with the strips in 2018.

 

[pellicle]

Does the Vantus machine calibrate automatically?

It's the same as the XS system, strips are where calibration occurs, this is why there is the code chip. The machine is simply a timer and date recorder. There is no need to do more.

 

[Sheenas7]

It's the same as the XS system, strips are where calibration occurs, this is why there is the code chip. The machine is simply a timer and date recorder. There is no need to do more.

Thank you Pellicle. That is reassuring.